Controversies and Cutting Edge

There is literature that challenges the accepted time to reduction of the dislocated hip and how much time truly increases the risk of avascular necrosis. Brav reviewed 262 patients and found that in patients reduced in < 12 hours, 22% developed avascular necrosis versus 52% in those reduced after 12 hours.81 Hougaard and Thompsen reviewed 100 cases after 5-year follow-up and found that 4% of patients reduced in < 6 hours developed avascular necrosis, versus 58% reduced > 6 hours.82 Dreinhofer et al evaluated 50 patients and reported that there was no difference in reduction < 1 hour as opposed to < 6 hours, all of which had a 12% risk of avascular necrosis.5